<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('门店编号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-store_no" class="form-control" name="row[store_no]" type="text">
        </div>
    </div>
    <!--<div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Requestno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-requestNo" class="form-control" name="row[requestNo]" type="text">
        </div>
    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Businessrole')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-businessRole" class="form-control selectpicker" name="row[businessRole]">
                {foreach name="businessroleList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Signname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-signName" class="form-control" name="row[signName]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Signtype')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-signType" class="form-control selectpicker" name="row[signType]">
                {foreach name="signtypeList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Licenceno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-licenceNo" class="form-control" name="row[licenceNo]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Licenceurlimage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-licenceUrlimage" class="form-control" size="50" name="row[licenceUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-licenceUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-licenceUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-licenceUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-licenceUrlimage" class="btn btn-primary fachoose" data-input-id="c-licenceUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-licenceUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-licenceUrlimage"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shortname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shortName" class="form-control" name="row[shortName]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Openaccountlicenceurlimage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-openAccountLicenceUrlimage" class="form-control" size="50" name="row[openAccountLicenceUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-openAccountLicenceUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-openAccountLicenceUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-openAccountLicenceUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-openAccountLicenceUrlimage" class="btn btn-primary fachoose" data-input-id="c-openAccountLicenceUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-openAccountLicenceUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-openAccountLicenceUrlimage"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Handlicenceurlimage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-handLicenceUrlimage" class="form-control" size="50" name="row[handLicenceUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-handLicenceUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-handLicenceUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-handLicenceUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-handLicenceUrlimage" class="btn btn-primary fachoose" data-input-id="c-handLicenceUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-handLicenceUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-handLicenceUrlimage"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Legalname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-legalName" class="form-control" name="row[legalName]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Legallicencetype')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-legalLicenceType" class="form-control selectpicker" name="row[legalLicenceType]">
                {foreach name="legallicencetypeList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Legallicenceno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-legalLicenceNo" class="form-control" name="row[legalLicenceNo]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Legallicencefronturlimage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-legalLicenceFrontUrlimage" class="form-control" size="50" name="row[legalLicenceFrontUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-legalLicenceFrontUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-legalLicenceFrontUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-legalLicenceFrontUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-legalLicenceFrontUrlimage" class="btn btn-primary fachoose" data-input-id="c-legalLicenceFrontUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-legalLicenceFrontUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-legalLicenceFrontUrlimage"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Legallicencebackurlimage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-legalLicenceBackUrlimage" data-rule="required" class="form-control" size="50" name="row[legalLicenceBackUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-legalLicenceBackUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-legalLicenceBackUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-legalLicenceBackUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-legalLicenceBackUrlimage" class="btn btn-primary fachoose" data-input-id="c-legalLicenceBackUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-legalLicenceBackUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-legalLicenceBackUrlimage"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contactname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contactName" class="form-control" name="row[contactName]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contactmobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contactMobile" class="form-control" name="row[contactMobile]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contactemail')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contactEmail" class="form-control" name="row[contactEmail]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contactlicenceno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contactLicenceNo" class="form-control" name="row[contactLicenceNo]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Servicephone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-servicePhone" class="form-control" name="row[servicePhone]" type="text">
        </div>
    </div>
    <!--<div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Primaryindustrycategory')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-primaryIndustryCategory" class="form-control" name="row[primaryIndustryCategory]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Secondaryindustrycategory')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-secondaryIndustryCategory" class="form-control" name="row[secondaryIndustryCategory]" type="text">
        </div>
    </div>-->
    <!--<div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Province')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-province" class="form-control" name="row[province]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('City')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-city" class="form-control" data-toggle="city-picker" name="row[city]" type="text"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('District')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-district" class="form-control" name="row[district]" type="text">
        </div>
    </div>-->
    <div class="form-group">
      <label class="control-label col-xs-12 col-sm-2">{:__('省市区')}:</label>
      <div class="col-xs-12 col-sm-8">
          <div class="form-inline" data-toggle="cxselect" data-selects="province,city,district">
              <select class="province form-control" name="row[province]" data-url="ajax/yeearea"></select>
              <select class="city form-control" name="row[city]" data-query-name="province" data-url="ajax/yeearea"></select>
              <select class="district form-control" name="row[district]" data-query-name="city" data-url="ajax/yeearea"></select>
          </div>
      </div>
 </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" class="form-control" name="row[address]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Settlementdirection')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-settlementDirection" class="form-control selectpicker" name="row[settlementDirection]">
                {foreach name="settlementdirectionList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bankaccounttype')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-bankAccountType" class="form-control selectpicker" name="row[bankAccountType]">
                {foreach name="bankaccounttypeList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bankcardno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bankCardNo" class="form-control" name="row[bankCardNo]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bankcode')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bankCode" class="form-control" name="row[bankCode]" type="text">
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('场景照')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-scenePhotoUrlimage" data-rule="required" class="form-control" size="50" name="row[scenePhotoUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-scenePhotoUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-scenePhotoUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-legalLicenceBackUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-scenePhotoUrlimage" class="btn btn-primary fachoose" data-input-id="c-scenePhotoUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-scenePhotoUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-scenePhotoUrlimage"></ul>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('门头照')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-businessPlacePhotoUrlimage" data-rule="required" class="form-control" size="50" name="row[businessPlacePhotoUrlimage]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-businessPlacePhotoUrlimage" class="btn btn-danger faupload" data-url="ajax/yeeupload" data-input-id="c-legalLicenceBackUrlimage" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-businessPlacePhotoUrlimage"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-businessPlacePhotoUrlimage" class="btn btn-primary fachoose" data-input-id="c-businessPlacePhotoUrlimage" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-businessPlacePhotoUrlimage"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-businessPlacePhotoUrlimage"></ul>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('小程序名称')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-wchatName" class="form-control" name="row[wchatName]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Notifyurl')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-notifyUrl" class="form-control" name="row[notifyUrl]" type="text">
        </div>
    </div>
    <!--<div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Merchantno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-merchantNo" class="form-control" name="row[merchantNo]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Applicationstatus')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="applicationstatusList" item="vo"}
            <label for="row[applicationStatus]-{$key}"><input id="row[applicationStatus]-{$key}" name="row[applicationStatus]" type="radio" value="{$key}" {in name="key" value="COMPLETED"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Applicationno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-applicationNo" class="form-control" name="row[applicationNo]" type="text">
        </div>
    </div>-->
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
